Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland

Both food insufficiency and HIV infection are major public health problems in sub-Saharan Africa, yet the impact of food insufficiency on HIV risk behavior has not been systematically investigated. We tested the hypothesis that food insufficiency is associated with HIV transmission behavior. We stud...

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Bibliographic Details
Published in:PLoS medicine 2007-10, Vol.4 (10), p.1589-1598
Main Authors: WEISER, S.D, LEITER, K, BANGSBERG, D, BUTLER, L.M, PERCY-DE KORTE, F, HLANZE, Z, PHALADZE, N, IACOPINO, V, HEISLER, M
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Analysis
Biological and medical sciences
Botswana
Botswana - epidemiology
Charitable foundations
Condoms
Condoms - economics
Condoms - statistics & numerical data
Confidence intervals
Cross-Sectional Studies
Demographic aspects
Disease transmission
Economic aspects
Eswatini
Eswatini - epidemiology
Female
Food security
Food supply
Food Supply - economics
Health aspects
Health care
HIV
HIV infection
HIV infection in women
HIV Infections - economics
HIV Infections - epidemiology
Human immunodeficiency virus
Humans
Hunger
Immune system
Infections
Infectious Diseases
Interpersonal Relations
Male
Malnutrition - economics
Malnutrition - epidemiology
Medical sciences
Miscellaneous
Nutrition
Poverty
Prevention and actions
Public Health and Epidemiology
Public health. Hygiene
Public health. Hygiene-occupational medicine
R&D
Research & development
Risk Factors
Risk-Taking
Sex Work
Sexual behavior
Women
Women's Health
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Summary:Both food insufficiency and HIV infection are major public health problems in sub-Saharan Africa, yet the impact of food insufficiency on HIV risk behavior has not been systematically investigated. We tested the hypothesis that food insufficiency is associated with HIV transmission behavior. We studied the association between food insufficiency (not having enough food to eat over the previous 12 months) and inconsistent condom use, sex exchange, and other measures of risky sex in a cross-sectional population-based study of 1,255 adults in Botswana and 796 adults in Swaziland using a stratified two-stage probability design. Associations were examined using multivariable logistic regression analyses, clustered by country and stratified by gender. Food insufficiency was reported by 32% of women and 22% of men over the previous 12 months. Among 1,050 women in both countries, after controlling for respondent characteristics including income and education, HIV knowledge, and alcohol use, food insufficiency was associated with inconsistent condom use with a nonprimary partner (adjusted odds ratio [AOR] 1.73, 95% confidence interval [CI] 1.27-2.36), sex exchange (AOR 1.84, 95% CI 1.74-1.93), intergenerational sexual relationships (AOR 1.46, 95% CI 1.03-2.08), and lack of control in sexual relationships (AOR 1.68, 95% CI 1.24-2.28). Associations between food insufficiency and risky sex were much attenuated among men. Food insufficiency is an important risk factor for increased sexual risk-taking among women in Botswana and Swaziland. Targeted food assistance and income generation programs in conjunction with efforts to enhance women's legal and social rights may play an important role in decreasing HIV transmission risk for women.
ISSN:1549-1277
1549-1676
1549-1676
DOI:10.1371/journal.pmed.0040260